Ebola in Sierra Leone is not just a health crisis

Members of a burial team remove the body of a 30-year-old man in Freetown, Sierra Leone [Getty Images]

In the Christian calendar, Christmas is cause for celebration - a symbol of hope founded in the birth of a saviour. But in Sierra Leone, this time of merriment offers no respite from the misery currently being suffered. Indeed, as recent headlines have proclaimed, Christmas has now been cancelled.

In the run-up to Christmas Day, Sierra Leoneans are once again under lockdown, following the prohibition of public gatherings to celebrate the occasion. The aim is to contain Ebola, the disease at the centre of a public health emergency in Sierra Leone, and neighbouring Guinea and Liberia.

On December 17, house-to-house searches, looking for the infected and deceased, were also announced. Such measures, although drastic, are essential in a context in which public mistrust of authority continues to fuel the epidemic.

This comes at a time when the outbreak has seemingly been brought under control in Liberia and Guinea.

In early December, reported cases in Sierra Leone leapfrogged those in Liberia, the erstwhile epicentre of the epidemic. According to the WHO, as of December 15, around 7,800 cases had been reported in Liberia, against almost 8,300 in Sierra Leone - a jump of 960 cases in under two weeks.

Much of the reason for this stems from flaws in responses to the outbreak. Indeed, internationally, global institutions and foreign governments failed to absorb the extent of the unfolding crisis. The WHO only declared a public health emergency in August.

Domestically, the government was also slow to recognise the potential scale of the epidemic. However, perhaps the greatest constraint has been the failure to recognise that in Sierra Leone, Ebola is not just a health crisis. It has also been fed by long-standing social issues, particularly a mistrust of authority engendered by the decade-long civil war.

Issues of security

As importantly, the epidemic has had serious security implications for a fragile society still rebuilding post conflict. These factors were not taken into account at first.

As noted by a senior international diplomatic source, the Sierra Leonean government initially decided that because it was a health issue, it would not invoke the national security architecture. Instead, the Ministry of Health was empowered over the Office of National Security, despite it clearly lacking the necessary coordination structures.

The armed forces - the RSLAF - were eventually authorised to support the domestic response in September, staffing checkpoints and providing static guards for whole districts under quarantine. They are also enforcing the Christmas lockdown.

As noted by a senior international security analyst, the involvement of the RSLAF has had a positive impact in terms of both public security and efforts at containment. Yet, had the security architecture been activated earlier, the outbreak could have been much more effectively contained from the start.

Meanwhile, future crisis-management plans should question assumptions about public receptiveness to government messaging. Certainly, the epidemic has shown just how much doubts about authority, in post-conflict settings can complicate crisis management.

In Sierra Leone, this has severely hampered containment: A pervasive lack of trust in the state - and by extension in doctors, policemen and government communications - is clearly evident even 12 years after the end of the civil war.

Similarly, international planning initially did not recognise that medical advice might not be received. Indeed, Ebola has been perceived variously by the public as a government-led conspiracy to attract donor funding and a plot to profit from organ harvesting. Attacks on health workers have also been common.

And, most importantly, the failure to convince a sceptical public to abandon familiar practices around traditional funerals has formed a petri-dish for the virus to flourish. Reports have emerged of families hiding deceased loved ones and paying bribes to allow secret burials - in spite of health workers' warnings. It is for this reason that the government has now decided house-to-house searches are necessary.

Learning lessons

Yet in managing this, and similar emergencies, effective public engagement must be much more strongly emphasised from the start. Here local ownership is essential. Civil society organisations can play a central role, and their outreach activities should be supported as a priority.

Alternative forms of communication could also be harnessed. In Sierra Leone, informal systems of governance remain strong, and using tribal and gender-based systems in addition to state structures is not only desirable, but completely necessary for effective public outreach.

This is an important lesson to emerge from an epidemic that has devastated so many lives. The challenge will be in finding the time and resources to identify good practice and act on it. Yet, it is vital that this take place.

We learn something from each crisis and the world's largest Ebola outbreak offers lessons that challenge our basic assumptions. These include the recognition that measures such as quarantining can be damaging if not comprehensively enforced.

In addressing these issues, as Sierra Leone emerges from the deepest throes of the crisis, building popular confidence will be as important as bolstering formal response mechanisms. After all, when facing an epidemic, it is the people who are on the frontline.

Equal attention must thus be directed, in the longer term, towards bridging the gulf between government and populace - the breadth of which Ebola has so painfully revealed.

In the meantime, the government must convince its citizens that even if Christmas is cancelled, the new year could offer fresh hope for a swift end to this crisis - providing authorities and people can work together towards this.

Cathy Haenlein is deputy editor of RUSI Newsbrief/associate editor of the RUSI Journal.

Ashlee Godwin is deputy editor of the RUSI Journal and a Fulbright scholar in national security policy-making.